Doc Ernie's Blog : Doc Ernie's Blog : Ernie Franz M.D. : Spinal Cord Injury, Disability, and Rehabilitation

 Traffic

Kisumu – two lane roads with no markings, poor shoulders, random speed bumps and potholes that would eat most suspensions and/or car tires and cars, mixed with piki-piki’s, tuk-tuk’s, matatu’s, bicycles and pedestrians. Piki-piki’s are a small 125cc engine motorcycle that carry from 1-4 people (I have heard up to 5). Matatu’s are everywhere and seat 14, but may carry more. They are usually a converted Toyota mini-van, of the bread loaf styling. Tuk-tuk’s are 3 wheeled and carry around 3-4 people. In general people walk everywhere, and carry a lot with them. Mix all this with cows, bulls, goats and the occasional 2 wheeled cart which generally use car tires. Any people moving vehicle may start and stop anywhere, the matatu’s the most erratic of the bunch. Vehicles are right hand drive. People walk everywhere in and amongst the traffic day and night. No traffic lights anywhere. Very little signage. No one anywhere wears bicycle helmets. Only the piki-piki drivers wear helmets, none of the passengers. People ride on the back of bicycles on a small seat, with small bars under the main seat. Some women well dressed ride side saddle and talk on cell phones as they ride.

Nairobi – very rare main roads are 4 or 6 lane. No speed limits posted, rare signage. People walking everywhere along the road side and crossing the roads day and night with very poor visibility and minimal overhead lights. Even these major roads have roundabouts, and u-turn options. Amongst all that are the matatu’s and larger buses. Again on major roads there are speed bumps not marked and the occasional big pothole. Coming back from the aiport to Hampton house at night, the road suddenly went from 6 lanes to 1.5 on each side, became rough and uneven and had big drop-offs on the shoulders, only marked by stones and rebar on the edge. No signage again about the narrowing or construction. Side roads generally very bumpy and some with major potholes and destroyed road surfaces. Very few major roads overall, mostly a network of rambling 2 lane roads all thru the city.

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 Today is my last full day in Kenya. Flight to Nairobi this eve.

Started the day with a visit to the Karunga school and almost 100 kids. No money for any sort of food program or supplements, which means most of the kids go without lunch at all. NIHS does a medical outreach here for de-worming and immunizations. Kids in bright purple uniforms, as usual smiling and giggling. They flood to anywhere a camera is shown! Met the teachers and looked at classrooms NI helped to fund and build. Momma Helen (aka Momma Jeff Krueger) was there to meet. We met Momma Mylka on the way to Karunga.

Also briefly toured the thatched roof hut village of Karunga itself. 

Back to Miwani. Packed out. Met nurse John who is quite personal and rides his bicycle once per week to work at NIHS while Esther is out doing immunizations/outreach. He is married to a nurse who also works in a health center. One child, 8 mos old.

He is most interested in preventative disease, and education that goes with that. He seems very interested to work more with NIHS.

Said goodbye to Esther and staff.

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 Our team met this morning with Grace, the Medical Officer (MO) in charge of our Miwani region, from the slope of the mountains to the railroad tracks, and from the bridge outside Kisumu then east to Miwani. Also Charles, a Community Health Worker (CHW), who may someday wish to work for NIHS. Discussion regarding our role and meeting regulations. She was encouraged by our incinerator, and services currently. She hopes we will ramp up quickly to provide these services (per the MDG’s): HIV/AIDS ARV’s, testing, follow-up and counseling; maternal care, TB, malaria, dehydration/diarrhea.

She can help set up training of CHW’s. Most are basic trained in 5 days, but in some regions they do more such as BP recording for Hypertension (HTN) screening, and fasting glucose. She does not think in our region these are problems – Diabetes and HTN. She thinks we need to train roughly 30 or more CHW’s. Additionally we will need a CO/MO position, 3-4 nurses total and a few more exam rooms. Inspections once we are ready to advance to a higher level of care. She feels we are a very important center for care to people from the bridge to the town of Miwani. Overall an encouraging meeting about our future role.

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 Kenya – Miwani/Nehemiah International

At the clinic this morning I spent some time with our staff and future potential staff; getting to know them and their background and experience.

Today we had a case of an elderly fellow (maybe 45-55) who has had intermittent fever, photophobia, headache, weakness. No diarrhea. Esther, our nurse, felt this was c/w either malaria or typhoid. Ken, our lab tech, was able to test for both, and it was typhoid. He received 1.0 gm iv Ceftriaxone. No iv fluids, just slow push of the drug. He is to return daily for 6 more days for additional iv doses.

Cisco is in her early 20’s. Here now briefly on school break. She is in school as a CO – or Clinical Officer. Just finished her first year. She will have 3 years of school, then 1 year of internship, which is sort of the payback time to the government. She can rank her top 3 choices, then will be placed at one of those. The school is state/Kenyan supported and costs 60,000 shillings per year (40,000 tuition + 20,000 living expenses [hostel and food]). She absolutely wants to work here when done with training. They do get basic sciences. Gross anatomy is using cadavers, but with someone dissecting for them. They can touch the cadaver if they wish, but do not have to. Otherwise sounds like PA school a bit; but not as thorough. I asked her about the brachial plexus, and she said that week the professor was not available, so it was discussed but not in that much detail.

The circumcision clinic seems, so far, to not be happening.  Last week a team had arrived to circumcise 6 males, and they were to have follow-up today.  For the procedure I understand they get Tylenol for pain relief!

We, Anneliese and I, headed for Kayo which is a small village near the town of Miwani. We were to visit Momma Mylka who is the grandmother to Jeff Krueger and Anna Schuler. After nearly 1.5 hours of rough road, single lane much of it, we are surrounded by trees and huts – some with thatched roofs, some with tin. Smooth hard dark dirt floors (which I later learned are cow dung and dirt), almost like concrete, mud walls supported with sticks inside. One or two windows per hut.....

The latrine is a 3 sided open structure, almost no privacy, used it appears just for stool; not likely urine.  Shallow hole covered in part by sticks and mud. Located maybe 40-50 feet from the nearest hut. Water for cooking/bathing/possibly drinking from a barely moving stream, which is “boiled” we are told. A nearby well provides most of the drinking water. Small gardens, a few goats or a small cow or two, small dogs and usually no cats.

Kids happy, swarm around me to shake my hand and want their photo taken. Most very happy and yell out “Mizunguu!!” or “How are you?”, especially the latter over and over! They especially wanted to see the photos I had just taken of them. Anna Schuler, almost 4 yo, was here, she ran to greet me and held my hand for the 200 meter walk into the village. One dog was snarling, and not too friendly, we stayed away given the recent rabies in the area.

On the way back we saw a currently closed dispensary in Miwani and the Make Me Smile project of orphan girls in a re-purposed pickle ball court. They have a pond for fish and small garden patches. The house mom appears maybe 20 yo. This house rented and supported by a few young Austrians whose father apparently gave them each some funds and told them to find a 3^rd world project to make a difference in peoples lives.  Around 8 girls living in this pickle ball court, ages roughly 8-20. Might have electricity, but we did no see any evidence of that.  Most homes, like this one, use a charcoal interior fire for cooking.  Usually a small, roughly 16 inches by 16 inches base that holds the burning coals just off the floor, with a pot on that for cooking Ugali or other items.  Yes, this does put out CO, or carbon monoxide.  Apparently the ventilation is good enough, as this is the standard everywhere - even in homes on the farm at NI.

Dinner back at the farm – Ugali and greens. 

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16 Feb 2012 - Miwani and Kisumu

My days are filled so far with medical facility evaluations and people meeting; making connections.

First the Nehemiah International Health Services building and staff –

Many photos taken today, and staff met. Esther, our Kenyan nurse, seems content and hard working; also very comfortable doing what she does.   No real sense of burn-out impending.  More on her on the next update.

Esther was thrilled to get her gifts today – new stethoscope, new headlamp – both from Dr. Dan Morris. I brought along some used equipment as well, all joyfully received.  They sure could use an otoscope to go with my tips I brought!

Lots of potential in our current building, just unsure how to use it all yet. Seems we need to get Dr’s. Omoto and Morris and nurse Anneliese – maybe Ken (our lab tech) too on skype and figure it out.

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Nairobi – 15 February 2012

Wow – it’s late.  The pics will tell the story when I can get them loaded.

Kibera slum today 7x10 km.  1-5 – 2.0 million people.  Vendors, phone cash, food, butchers, sheep, dogs, cows, goats, kids and more kids.  Sewage stench everywhere.

Walked in with Pastor John, Aaron, Jeff, our nurse and myself + 3 soldiers with AK-47’s or Kalishnakov’s.  5000 shillings for the escort – since 3 Muzunguus’ were robbed of all they had  last week.

Amazing – I do not ever want to forget it, nor the kids and somehow this is all they know – the look on their faces and still joy.  Several schools along the way until we hit the WorldComm site with 96 kids ages maybe 3-10 in a one room schoolhouse.  All in uniform, orderly and seated quietly.  They sang, recited scripture, and clapped!!  There were some trinkets there to purchase, made on site – so a few items were bought.

They paid for a car ride out for me with Aaron and a security guard.  Crazy bumpy single lane road – not really a road.

Wow….the red clay and dust and smells stuck with me all day – I could taste it through the dust in my mouth and nostrils – no water safe anywhere.

Then to another school. 270 kids, taught well – some orphans.  High achievers.  Many place in the top regionally when testing to advance.  Sports – soccer, volleyball.  They waited to feed everyone as they knew we were coming.  Orderly serpentine line to feed, youngest to oldest.  Many teachers – grades 1-8.  Teachers volunteer or a small stipend.  All passionate about education, Christ, scripture.  Songs and poems for us as well.  They also kindly served us each a cola w straw!!  It was almost cool, but the taste divine coming from Kibera.

Barely to the airport in time to fly to Kisumu and then the drive to Miwani.  Dinner at 8:20pm.  Windy, stars, clear – yet cane fires on the distant hill.  My first “at risk” mosquito bites this eve.  They are small and appear out of nowhere.

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 Lots to report - and the days so full, it is hard to take notes, swat mosquitoes, snap pics and somehow process it all; the good news = that is happening!!  Yet my intentions of updating this blog are proving a bit difficult.  I have some amazing photos to share, yet my connection slow enough it is difficult to upload any photos.

I will re-edit these comments when I have the time, but for now, easier to simply upload my notes and correct them later.

Kenya – Nairobi  14 Feb 2012

Exchange rate info for you -  $1 USD = 83.5 shillings 

Walked maybe a mile to B-fast.  The Java Hut.

1.  Off to Hurlingham Private Women’s Hospital in Nairobi.  61 beds; 61 nurses.  Converted from a hotel to a hospital in 2001.  Generally 90% occupancy. 

Casualty requires first generating a hospital MR #, then pre-paying for your casualty visit, then being seen.  Very kind people all along the way working in this nice private hospital, yet in tight spaces.  Medical records is amazing – crazy piles of charts piled high and rubber banded together.

The IT dept is staffed by 2 people who are surrounded by junked out monitors and towers.  Their goals seem to be more about computer info RE: staffing, laundry and benefits for staff, than about actual MR’s.  No intent to go to an EMR, no intent to put a patient’s labs or x-rays or PMH in the computer.  No intent or plan to connect all 3 of their private hospitals together with one computer system.  Suggested it would be nice to pull up doctor notes, RN notes, patient history, meds, HIV status, last admit, current plan, even current admission – but NONE of this is available; nor any plans to make it available.  Yet they rated their IT system an 8/10 (??? Amazing!!!)

Delivery costs 40,000 shillings and a 2 day stay; C-Section 150,000 shillings and a 3-4 day stay.

[talking to Dr. Omoto over dinner his hospital in Siaya District charges 500 shillings for NSVD and 3,000 shillings for a C-section.]

They do transfer people out who cannot pay to other public hospitals.

They had 1-3 beds for males. 

1 ultrasound machine, 1 x-ray machine.  No back-up.

Lab runs 24/7 with something like 7 people in a small cramped area maybe 200 sq feet.  The lab machines “free”, but they pay for reagent and tubes, etc…..  Blood bank, TnC, HIV, and apparently send out very few things.

Doctor’s offices in bldg.  Generally clean and yet open windows, ventilation.  No AC.  A rare fan or two.  Equipment everywhere looks like it is mostly from the late 60’s – early 70’s.  Yet a lot of pride in what they do and how they do it.

Please read on for more from this same day........2.  Next – Kenyatta National Hospital (KNH)........

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 As I write this, I am on my way to Kenya, to an area east of Kisumu to help with the advancement of a current medical dispensary to become a healthcare center with increased services and staffing.  I am thrilled to be a part of this!  

It should be an interesting time with its own challenges.  I Skyped with our nurse Anneliese yesterday and found she had questions of how to best treat a woman whom had been "squeezed" by a python and has evidence of crush injuries and bruising.  Also the CDC of Kenya reported yesterday an outbreak of rabies in the area east of Kisumu; and that with limited to nonexistent access to rabies vaccine and rabies immune globulin.  I will not be petting or getting close to any dogs, that is for certain.  Though monkeys, cows and even rabbits can be carriers, I find it difficult to be suspicious of them.

Here is an email I sent to my friends and family just days ago regarding the adventure.....

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